Hip Arthroscopy

What is Arthroscopy?

Over the last thirty years, the combination of video technology with flexible and rigid telescopes and pencil thin instruments has enabled surgeons to replace many traditional surgical procedures with less invasive operations that are less traumatic for patients and provide a quicker post-operative recovery. In orthopaedics, the term arthroscopy or arthroscopic is applied to such procedures. The term is derived from two ancient Greek words, άρθρον (arthron, an “articulation” or “joint”) and σκοπέω (skopéō, “look (out) for”).

An arthroscope with digital camera

Hip Arthroscopy

In orthopaedic practice, arthroscopic surgery was initially adopted for operations in knees and shoulders because these joints are large, relatively easy to access and there were many traditional operations that could be replaced by arthroscopic solutions. In contrast, the hip is the most deeply set joint in the body and with the exceptions of hip replacement, periacetabular osteotomy and proximal femora osteotomy, relatively few operations had been developed to treat hip arthritis and pre-arthritic problems.

The hip joint

The role of Hip Arthroscopy

In the late 1990’s and early 2000’s hip surgeons began to recognise patterns of damage that were affecting younger patients and were triggers for later joint degeneration. It was recognised that not all people have hip joints with a perfectly spherical femoral head (the ball at the top of the thigh bone) and there is considerable variation in the depth and orientation of the acetabular socket (the recess in the pelvis that the femoral head fits into). When there is repetitive impact or impingement of the femoral head and acetabular rim, the labrum (the flexible rim of the acetabular socket) can be damaged and arthroscopic procedures have been devised both to repair the damaged labrum and to remove the bone that is causing the impingement.

Normal hip

Cam hip

Pincer hip

An evolving sub-specialty

Over the last twenty years a growing number of surgeons have learnt how to undertake arthroscopic procedures in and around the hip joint both for hip impingement and to repair damage to the ligaments and tendons that support the joint. At the London Hip Practice, Prof Field is one of the world’s most experienced hip arthroscopists. He has been President of the International Society for Hip Preservation Surgery (ISHA), is a board member of the Journal of Hip Preservation Surgery and has undertaken a number of world first hip preserving operations.

A healthy labro-chondral junction

Labro-chondral disruption

Adjacent chondral (cartilage) delamination

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